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Pharma: 8088 -
#1 Aminophylline: a) Reduces intracellular cAMP. b) Is a
non-selective adenosine agonist. c) Inhibits the effects of
dipyridamole. d) Is longer acting than theophylline.
Explanations: a) F. Aminophylline acts as a phosphodiesterase
inhibitor and therefore increases intracellular cAMP. It also
activates protein kinase A, inhibits TNF-alpha and inhibits
leukotriene synthesis. b) F. Aminophylline is a non-selective
adenosine antagonist c) T. The statement is true. d) F.
Aminophylline is less potent and shorter acting than
theophylline.
Pharma: 8135 -
#2 Paracetamol (acetaminophen): a) Has 100% bioavailability. b)
Has a half-life of 30 minutes. c) Inhibits COX-3 receptors in the
brain and spinal cord. d) Toxicity is primarily due to glutathione
production.
Explanations: a) T. Paracetamol has 100% bioavailability b) F.
Paracetamol has a half-life of 1-4 hours. c) T. Paracetamol is
thought to work by selectively inhibiting COX-3 receptors in the
brain and spinal cord. COX-3 is responsible for the production of
prostaglandins in these areas, which sensitizes free nerve endings
to the chemical mediators of pain. Therefore by selectively
inhibiting COX-3 paracetamol effectively reduces pain sensation. d)
F. N-hydroxylation via the hepatic cytochrome p450 enzyme system is
responsible for the production of NAPQI (N-acetyl-p-benzo-quinone
imine). NAPQI is primarily responsible for the toxic effects of
paracetamol. NAPQI is an intermediate product and is subsequently
irreversibly conjugated with the antioxidant glutathione to produce
an inactive, non-toxic, metabolite.
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Pharma: 8066 -
#3 Regarding warfarin: a) It should be avoided in pregnancy. b)
The risk of bleeding is increased with co-prescription of
ibuprofen. c) Warfarin necrosis is more common in patients with
protein C deficiency. d) The INR should be between 3 and 4 for the
treatment of DVT.
Explanations: a) T. Warfarin passes across the placenta and may
cause bleeding in the fetus. b) T. The bleeding risk of warfarin is
increased when warfarin is co-prescribed with antiplatelet agents,
NSAIDs and aspirin. c) T. Warfarin necrosis is a rare complication
of warfain administration that causes massive thrombosis with skin
necrosis and limb gangrene. It is associated with protein C and S
deficiency. d) F. The target INR is between 2 and 3 for the
treatment of DVT.
Pharma: 8109
#4 Digoxin specific antibodies fragments (Digibind): a) Are made
from immunoglobulin fragments from cattle. b) Are the
antigen-binding fragments of the antibodies. c) Use should be
reserved for cases of severe poisoning only. d) Work by binding to
the action site on target cells.
Explanations: a) F. Digoxin specific antibodies are made from
immunoglobulin fragments from sheep. b) T. The statement is true.
c) T. The use of digibind should be reserved for severe cases of
digoxin poisoning when measures beyond the withdrawal of the drug
and correction of electrolyte abnormalities are felt to be
necessary. d) F. Digibind works by binding to digoxin and
preventing it from binding to the action site on target cells.
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Pharma: 8035 -
#5 Regarding vasopressors and inotropes: a) Noradrenaline
reduces afterload and is therefore inappropriate to use in the
treatment of cardiogenic shock. b) Noradrenaline is an alpha and
beta2 agonist. c) Isoproterenol is a powerful alpha agonist. d) The
IM dose of adrenaline in anaphylaxis is 0.5 mL of 1:1000.
Explanations: a) F. Noradrenaline increases afterload and is
used in the management of cardiogenic shock. b) F. Noradrenaline is
an alpha and beta1 agonist with no clinically significant beta2
effects. c) F. Isoproterenol is a powerful beta agonist with
virtually no alpha effects. d) T. The statement is true.
Pharma: 8057 -
#6 Regarding amiodarone: a) It prolongs phase III of the cardiac
action potential. b) Its side effects include hyperthyroidism. c)
The loading dose in the treatment of ventricular tachycardia is 300
mg IV. d) It has a lower efficacy than dronedarone.
Explanations: a) T. Amiodarone prolongs phase III of the cardiac
action potential, the repolarisation phase, where there is
increased potassium and reduced calcium permeability. b) T.
Amiodarone chemically structurally thyroxine and is can cause both
hyperthyroidism and hypothyroidism. c) T. The loading dose in the
treatment of ventricular tachycardia is 300 mg IV. d) F.
Dronedarone has a lower efficacy than amiodarone but also has a
lower incidence of side effects.
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Pharma: 8071 -
#7 Heparin: a) Binds to the enzyme inhibitor antithrombin II. b)
Has a duration of action of 4 to 6 hours. c) Is more effective than
its low molecular weight derivates in preventing mortality from
thrombosis. d) Overdose can be treated with vitamin K.
Explanations: a) F. Heparin binds to and activates the enzyme
inhibitor antithrombin III. Antithrombin III forms a 1:1 complex
with thrombin and inactivates it. The heparin-antithrombin III
complex also inhibits factor Xa and some other proteases involved
with clotting. b) T. The statement is true. c) F. There is no
evidence that heparin is superior to LMWH in preventing mortality
from thrombosis. d) F. Vitamin K can be used to reverse the effects
of warfarin but not heparin. Protamine sulphate is used to
counteract the effects of heparin.
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Pharma: 8127 -
#6 Regarding salicylate poisoning: a) Ingestion of greater than
125 mg/kg and less than 250 mg/kg of aspirin is associated with
mild toxicity. b) Hyperpyrexia is a risk factor for death in severe
poisoning. c) Haematemesis is a common feature. d) The typical
acid-base picture is a mixed respiratory and metabolic
acidosis.
Explanations: a) T. Ingestion of greater than 125 mg/kg is
associated with mild toxicity, greater than 250 mg/kg with moderate
toxicity and greater than 500 mg/kg with severe and potentially
fatal toxicity. b) T. Risk factors for death in severe poisoning
include: Age < 10 or > 70 years CNS features Metabolic
acidosis Hyperpyrexia Late presentation Pulmonary oedema Salicylate
concentration > 700 mg/L c) F. Haematemesis is an uncommon
feature of salicylate poisoning. Common features include: Nausea
and vomiting Tinnitus Lethargy Dizziness Restlessness Sweating
Bounding pulses Warm extremities Hyperventilation d) F. The typical
acid-base picture is a mixed respiratory alkalosis and metabolic
acidosis with a normal or high arterial pH.
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Pharma: 8026 -
#5 Dobutamine: a) Is a derivative of isoprenaline. b) Reduces
cell membrane permeability to calcium ions. c) Acts on
catecholamine receptors. d) May precipitate atrial
fibrillation.
Explanations: a) T. Dobutamine is a synthetic isoprenaline
derivative. b) F. Dobutamine increases cell membrane permeability
to calcium ions. c) T. Dobutamine acts on catecholamine receptors
to actvate adenyl cyclase. This catalyses the conversion of ATP to
cAMP and subsequently increases membrane permeability to calcium
ions. d) T. Dobutamine enhances AV nodal conduction and may
precipitate AF in predisposed patients.
Pharma: 8020 -
#4 Regarding phaeochromocytoma: a) Beta blockers such as
atenolol should be used to manage hypertensive crises. b) Alpha
blockers such as phenoxybenzamine should be used prior to surgery.
c) 30% of tumours are bilateral. d) 80% of tumours are
solitary.
Explanations: a) F. Pure beta blockade can result in unopposed
alpha agonism and result in severe refractory hypertension. b) T.
The use of irreversible alpha blockers such as phenoxybenzamine is
important as a massive release of catecholamines from the tumour
may overcome reversible blockade. c) F. 10% of tumours are
bilateral. d) T. 80% of tumours are solitary and unilateral, 10%
are extra-adrenal and 10% bilateral.
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Pharma: 8066 -
#3 Regarding warfarin: a) It should be avoided in pregnancy. b)
The risk of bleeding is increased with co-prescription of
ibuprofen. c) Warfarin necrosis is more common in patients with
protein C deficiency. d) The INR should be between 3 and 4 for the
treatment of DVT.
Explanations: a) T. Warfarin passes across the placenta and may
cause bleeding in the fetus. b) T. The bleeding risk of warfarin is
increased when warfarin is co-prescribed with antiplatelet agents,
NSAIDs and aspirin. c) T. Warfarin necrosis is a rare complication
of warfain administration that causes massive thrombosis with skin
necrosis and limb gangrene. It is associated with protein C and S
deficiency. d) F. The target INR is between 2 and 3 for the
treatment of DVT.
Pharma: 8081 -
#2 Hydrocortisone: a) Long term usage can cause osteoporosis. b)
Has poor oral bioavailability. c) Is 10 times more potent than
dexamathasone. d) Is longer acting than prednisolone.
Explanations: a) T. Long term usage of hydocortisone and other
corticosteroids can cause diabetes, hypertension, osteoporosis and
fragility fractures and avascular necrosis of the femoral head. b)
F. Hydrocortisone has 96% oral bioavailability and is 90% bound to
plasma proteins. c) F. Dexamethasone is 25 times more potent than
hydrocortisone. d) F. Prednisolone is longer acting than
hydrocortisone. The half-life of hydrocortisone is approximately
100 minutes. The half-life of prednisolone is approximately 3-4
hours.
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Pharma: 8082 -
#1 Prednisolone: a) Binds with alpha and beta glucocorticoid
receptors. b) Inhibits gene transcription for COX-2. c) Is 25 times
more potent than dexamethasone. d) Has a longer half-life than
dexamethasone.
Explanations: a) T. Prednisolone binds with both alpha and beta
glucocorticoid receptors. b) T. The statement is true. c) F.
Dexamethasone is approximately 6 times more potent than
prednisolone. d) F. Prednisolone has a half-life of 3-4 hours.
Dexamethasone has a half-life of 36-54 hours.
Pharma: 8069 -
#10 Drugs that should be routinely monitored include: a)
Teicoplanin. b) Aminophyllin. c) Lithium. d) Sodium valproate.
Explanations: a) F. Teicoplanin does not require monitoring. b)
T. Drugs that require routine monitoring include: gentamicin,
digoxin, theophyllines, phenytoin, lithium and cyclosporin. c) T.
The statement is true. d) F. The statement is false.
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Pharma: 8031 -
#7 Metaraminol: a) Acts mainly as an alpha1 adrenergic receptor
agonist. b) Causes a reflex bradycardia. c) Should be used in small
bolus doses of 0.5-1mg and titrated to effect. d) Onset of effect
following intravenous injection is within 1-2 minutes.
Explanations: a) T. It also has some effect on beta adrenergic
receptors. b) T. The statement is true. c) T. The statement is
true. d) T. The statement is true.
Pharma: 8090 -
#7 The following drugs are matched with their correct antidotes:
a) Beta-blockers glucagon. b) Heroin naloxone. c) Ethylene glycol
omeprazole d) Gliclazide atropine.
Explanations: a) T. The statement is true. b) T. The statement
is true. c) F. The antidotes for ethylene are alcohol and
fomepizole. d) F. The antidotes for sulphonylureas are glucose and
octreotide.
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Pharma: 8101 -
#6 Regarding the extrapyramidal side effects of antipsychotic
drugs: a) Dystonia occurs more commonly in children. b) Akathisia
is characterized by an inability to initiate movement. c)
Haloperidol is the most common causative antipsychotic drug. d)
Tardive dyskinesia is always reversible on withdrawal of the
causative drug.
Explanations: a) T. Dystonia (abnormal face and body movements)
is more common in children and young adults and tends to appear
after only a few doses. b) F. Akathisia is characterized by an
unpleasant sensation of restlessness. Akinesia is an inability to
initiate movement. c) T. The statement is true. d) F. Tardive
dyskinesia (rhythmic, involuntary movements of tongue, face and
jaw) usually develops after long-term treatment or with high
dosage. It is the most serious manifestation of extrapyramidal
symptoms as it may be irreversible on withdrawing the causative
drug and treatment is generally ineffective.
Pharma: 8048 -
#2 Pabrinex contains the following vitamins: a) Folic acid. b)
Vitamin C. c) Vitamin B1. d) Vitamin B12.
Explanations: a) F. Pabrinex contains thiamine (vitamin B1),
riboflavin (vitamin B2), nicotinamide (vitamin B3, niacin and
nicotinic acid), pyridoxine (vitamin B6) and ascorbic acid (vitamin
C). b) T. The statement is true. c) T. The statement is true. d) F.
The statement is false.
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Pharma: 8076 -
#1 Salbutamol: a) Is a short acting beta2-adrenergic receptor
agonist. b) Can be used as a tocolytic. c) A standard metered dose
inhaler carries a dose of 200 micrograms per metered inhalation. d)
Can cause potentially serious hyperkalaemia.
Explanations: a) T. The statement is true. b) T. Intravenous
salbutamol can be used as a tocolytic agent to relax uterine smooth
muscle and delay premature labour. c) F. A standard metered dose
inhaler carries a dose of 100 micrograms per metered inhalation. d)
F. Salbutamol can cause potentially serious hypokalamia.
Pharma: 8137 -
#10 Regarding paracetamol overdose: a) If a patient has ingested
less than 75 mg/kg it is unlikely that serious toxicity will occur.
b) The initial loading dose of acetylcysteine is 150 mg/kg over 1
hour. c) An adverse reaction to acetylcysteine is more likely in
patients with a family history of allergy. d) Abdominal pain is a
common early feature.
Explanations: a) T. The statement is true. b) T. The full course
of treatment with acetylcysteine comprises 3 consecutive
intravenous infusions: 1st infusion: 150 mg/kg over 1 hour 2nd
infusion: 50 mg/kg over the next 4 hours 3rd infusion: 100 mg/kg
over the 16 hours c) T. Adverse effects to acetylcysteine are more
common in women, asthmatics and in patients with a family history
of allergy. d) F. Nausea and vomiting are common early features
following paracetamol overdose. Abdominal pain does not typically
occur until 12-36 hours following overdose in severe cases.
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Pharma: 8030 -
#8 Ephedrine: a) Causes the release of noradrenaline from
sympathetic nerve terminals. b) Increase cardiac contractility and
heart rate. c) The duration of action when administered
intravenously is approximately 10 minutes. d) Causes
bronchodilatation.
Explanations: a) T. The statement is true. b) T. The statement
is true. c) F. When administered intravenously the drugs effects
are very rapid and the duration of action is approximately 1 hour.
d) T. The statement is true.
Pharma: 8111 -
#6 The following are recognized side effects of typical
neuroleptic drugs: a) Akathisia. b) Parkinsonism. c) Dystonia. d)
Neuroleptic malignant syndrome.
Explanations: a) T. The typical, or first generation,
neuroleptics include chlorpromazine, pipotiazine, prochlorperazine
and haloperidol. They tend to block dopamine pathways in the brain
and have prominent extrapyramidal side effects including
parkinsonism, dystonia, akinesia, akathisia and tardive dyskinesia.
b) T. The statement is true. c) T. The statement is true. d) T.
Neuroleptic malignant syndrome is an adverse reaction to
neuroleptic drugs. The syndrome consists of muscle rigidity,
pyrexia, autonomic instability and cognitive changes. There is
usually also an elevated plasma creatine kinase level.
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Pharma: 8139 -
#4 Morphine: a) Is an alkaloid. b) Has 50-80% oral
bioavailability. c) Causes local histamine release. d) Should be
used first line in the management of acute cardiogenic pulmonary
oedema (ACPO).
Explanations: a) T. Morphine is an alkaloid opiate analgesic
drug. b) F. Morphine has 20-40% oral bioavailability, 35-70% rectal
bioavailability and 100% intravenous bioavailability. c) T.
Morphine causes local histamine release which can cause itching and
flushing of the skin. It can also trigger wheeze in asthmatics and
anaphylactoid reactions. d) F. Morphine should no longer be used in
the management of acute decompensated heart failure and ACPO due to
an increased risk of adverse events. The ADHERE analysis, published
in 2008, revealed a greater risk of mechanical ventilation,
prolonged hospitalization, ICU admission and mortality when used in
these patients.
Pharma: 8122 -
#3 Ondansetron: a) Is a 5-HT3 receptor agonist. b) Has
antimuscarinic effects. c) Tends to cause a tachycardia. d) Is
excreted renally.
Explanations: a) F. Ondansetron is a 5-HT3 receptor antagonist.
b) F. Ondansetron has no effect on muscarinic or dopamine
receptors. c) F. Tachycardia is commonly seen with other
anti-emetics such as cyclizine but this is not the case with
ondansetron. d) T. Ondansetron is excreted renally and has a
half-life of approximately 6 hours.
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Pharma: 8100 -
#1 Regarding antipsychotic drugs: a) Extrapyramidal side effects
occur most commonly with the piperazine phenothiazines and
butyrophenones. b) Doses should be reduced in renal impairment. c)
Haloperidol is the first-line drug for dementia-related psychosis.
d) Haloperidol is a phenothiazine derivative.
Explanations: a) T. Extrapyramidal side effects occur most
commonly with the piperazine phenothiazines (fluphenazine,
prochlorperazine and trifluoperazine) and butyrophenones
(benperidol and haloperidol). b) T. There is increased cerebral
sensitivity in renal impairment and reduced doses should be used.
c) F. There is an increased risk of mortality in elderly patients
with dementia-related psychosis treated with haloperidol. This
appears to be due to increased risk of cardiovascular events and
infections such as pneumonia. d) F. Haloperidol is a butyrophenone
derivative.
Pharma: 8108 -
#5 Regarding digoxin toxicity: a) Xanthopsia is a common
feature. b) Female gender is a recognized risk factor. c) Severe
toxic effects are generally seen at levels greater than 2.0 g/l. d)
Activated charcoal should be given if the patient presents within 1
hour of an overdose involving digoxin.
Explanations: a) F. Xanthopsia is a rare feature of digoxin
toxicity. b) F. Risk factors for digoxin toxicity include: Age over
55 Male gender Underlying heart disease Pre-existing renal failure
c) F. The therapeutic range of digoxin is 1-2 g/l. Severe toxic
effects are generally seen at levels greater than 4.0 g/l. d) T.
Repeated doses of activated charcoal can be used and are thought to
be of value in increasing elimination.
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Pharma: 8097 -
#1 Regarding chlordiazepoxide: a) It has a half-life of 5-30
hours. b) It is commonly used as an adjunct in alcohol withdrawal.
c) The dose should be reduced in patients with renal impairment. d)
Has predictable intramuscular absorption.
Explanations: a) T. The statement is true. b) T.
Chlordiazepoxide is commonly used as an adjunct in alcohol
withdrawal. Diazepam is a suitable alternative and also commonly
used. c) T. Patients with renal impairment have increased cerebral
sensitivity to benzodiazepines. If treatment is required reduced
doses should be used. d) F. Lorazepam is the only benzodiazepine
with predictable intramuscular absorption.
Pharma: 8086 -
#4 Drug doses in adult asthma: a) Terbutaline 5 mg via
oxygen-driven nebuliser. b) Prednisolone 40-50 mg orally. c)
Aminophylline 25 mg/kg IV loading dose over 20 minutes. d)
Magnesium sulphate 1.2-2 mg IV.
Explanations: a) F. Terbutaline can be used instead of
salbutamol and the dose is 10 mg via oxygen-driven nebuliser. b) T.
The statement is true. c) F. Aminophylline 5 mg/kg IV loading dose
over 20 minutes. d) F. Magnesium sulphate 1.2-2 g IV (over 20
minutes).
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Pharma: 8005 -
#5 Regarding proton pump inhibitors. a) They are associated with
an increased risk of Clostridium Difficile infection. b) Long term
use is associated with an increased risk of pelvic fractures. c)
They are associated with an increased risk of bradyarrhythmias. d)
Long term use can cause low serum magnesium levels.
Explanations: a) T. It is suspected that acid suppression
results in poor elimination of pathogenic organisms leading to
increased infection risk. b) F. Long term use has been associated
with an increased risk of hip, wrist and spine fractures but not
pelvic fractures. c) F. They are associated with an increased risk
of focal tachyarryhtmias. See Marcus et al. Innnovations in Cardiac
Rhythm Managament 2010. d) T. This was highlighted by the US FDA in
March 2011.
Pharma: 8022 -
#6 ACE inhibitors have been shown to: a) Reduce the progression
of diabetic nephropathy. b) Reduce cardiac cachexia in heart
failure. c) Reduce mortality in heart failure. d) Cause lung
fibrosis.
Explanations: a) T. Epidemiological studies have shown this
effect to be independent of their anti-hypertensive action. b) T.
The statement is true. c) T. Meta-analysis has shown ACE inhibitors
to result in a 28% reduction in death, MI and overall admission. d)
F. They cause a dry cough but there is no proven causal link to
lung fibrosis.
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Pharma: 8103 -
#7 Regarding the extrapyramidal side effects of antipsychotic
drugs: a) Acute dystonia is a recognized cause of jaw dislocation.
b) Akinesia is characterized by restlessness. c) Clozapine is the
most common causative antipsychotic drug. d) Acute dytsonia can be
treated with cyclizine.
Explanations: a) T. The statement is true. b) F. Akathisia is
characterized by an unpleasant sensation of restlessness. Akinesia
is an inability to initiate movement. c) F. Haloperidol is the most
common causative antipsychotic drug. Clozapine generally has fewer
extrapyramidal side effects and is the drug of choice in the
treatment of Parkinsons disease patients that require antipsychotic
treatment. d) F. Acute dystonia can be treated with procyclidine
5mg IV or benzatropine 2mg IV as a bolus.
Pharma: 8119
#8 Cyclizine: a) Has antihistamine properties. b) Has
antimuscarinic properties. c) Commonly causes extrapyramidal side
effects. d) Can cause urinary retention in patients with prostatic
hypertrophy.
Explanations: a) T. Cyclizine is a piperazine derivative with
antihistamine (H1-receptor antagonist) properties. It is thought to
act on the chemoreceptor trigger zone (CTZ) and the labyrinthine
apparatus to prevent nausea and vomiting. It also has
antimuscarinic effects. b) T. The statement is true. c) F.
Extrapyramidal side effects can occur with cyclizine, but only
rarely. The commonest side effects are drowsiness and dry mouth. d)
T. Cyclizine has antimuscarinic effects and can precipitate urinary
retention in patients with prostatic hypertrophy.
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Pharma: 8070 -
#9 Drugs that should be routinely monitored include: a)
Gentamicin. b) Vancomycin. c) Phenytoin. d) Cyclosporin.
Explanations: a) T. Drugs that require routine monitoring
include: Gentamicin, digoxin, theophyllines, phenytoin,
carbemazepine, lithium and cyclosporin. b) F. Vancomycin monitoring
is only recommended in patients with renal impairment, children and
morbidly obese patients. c) T. The statement is true. d) T. The
statement is true.
Pharma: 8007
#10 Regarding diuretics: a) Furosemide can cause a diuresis of
20% of the filtered load of NaCl and water. b) Bendroflumethiazide
can result in hypocalcaemia. c) Mannitol is freely reabsorbed at
the glomerulus. d) Acetazolamide is useful in aspirin overdose.
Explanations: a) T. Loop diuretics are high ceiling diuretics
and can cause a substantial diuresis. b) F. Thiazide diuretics are
calcium sparing and result in a low rate of excretion of calcium.
c) F. Mannitol is an osmotic diuretic which is filtered at the
glomerulus but cannot be reabsorbed. d) T. Acetazolamide can be
used to alkalinize the urine in salicylate poisoning.
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Pharma: 8059
#1 The following are cytochrome p450 enzyme inducers: a)
Omeprazole. b) Sulphonamides. c) Rifampicin. d) Erythromycin.
Explanations: a) F. Omeprazole is a cytochrome p450 enzyme
inhibitor. b) F. Sulphonamides are cytochrome p450 enzyme
inhibitors. c) T. The mnemonic PC BRASS can be used to memorise the
commonly encountered cytochrome p450 enzyme inducers: P Phenytoin C
Carbemazepine B Barbiturates. R Rifampicin A Alcohol (chronic
ingestion) S Sulphonylureas S Smoking d) F. Erythromycin is a
cytochrome p450 enzyme inhibitor.
Pharma: 8123
#2 Milrinone: a) Is a phosphodiesterase inhibitor. b) Is
contraindicated in heart failure. c) Can cause atrial arrhythmias.
d) Has a half-life of 2-3 minutes.
Explanations: a) T. Milrinone is a phosphodiesterase-3 inhibitor
that increases myocardial contractility. It also acts by causing
vasodilatation thus reducing afterload. It is used as a positive
inotrope in the treatment of heart failure. b) F. The statement is
false. c) T. Milrinone can cause atrial fibrillation and other
arrhythmias particularly if used following cardiac surgery. d) F.
Milrinone has a half-life of 2-3 hours.
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Pharma: 8062
#4 The following are cytochrome p450 enzyme inhibitors: a)
Barbiturates. b) Chronic alcohol ingestion. c) Clarithromycin. d)
Sulphonamides.
Explanations: a) F. Barbiturates are cytochrome p450 enzyme
inducers. b) F. Chronic alcohol ingestion causes induction of
cytochrome p450 enzymes whilst acute alcohol ingestion causes
inihibition of cytochrome p450 enzymes. c) T. The mnemonic O
DEVICES can be used to memorise the commonly encountered cytochrome
p450 enzyme inhibitors: O - Omeprazole D - Disulfram E -
Erythromycin (and other macrolide antibiotics) V - Valproate
(sodium valproate) I - Isoniazid C - Ciprofloxacin E - Ethanol
(acute ingestion) S - Sulphonamides d) T. The statement is
true.
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Pharma: 8136
#5 Regarding paracetamol (acetaminophen): a) It is primarily
metabolized by the hepatic cytochrome p450 enzyme system. b)
Glucuronidation of paracetamol is responsible for the production of
the toxic metabolite NAPQI. c) It is excreted renally. d) It has
anti-pyretic effects.
Explanations: a) F. Paracetamol is metabolized by 3 main
metabolic pathways in the liver: 1. Glucuronidation (40-60%) 2.
Sulfate conjugation (20-40%) 3. N-hydroxyloxation via the hepatic
cytochrome p450 enzyme system (10-15%) b) F. N-hydroxylation via
the hepatic cytochrome p450 enzyme system is responsible for the
production of NAPQI (N-acetyl-p-benzo-quinone imine). NAPQI is
primarily responsible for the toxic effects of paracetamol. NAPQI
is an intermediate product and is subsequently irreversibly
conjugated with the antioxidant glutathione to produce an inactive,
non-toxic, metabolite. c) T. All three pathways of paracetamol
metabolism produce non-toxic metabolites that are excreted renally.
d) T. Paracetamol selectively inhibits COX-3 in the brain and
spinal cord. This results in inhibition of prostaglandin production
and subsequently analgesic and antipyretic effects.
Pharma: 8023
#7 Therapeutic causes of gynaecomastia include: a) Cimetidine.
b) Spironolactone. c) Digoxin. d) Aspirin.
Explanations: a) T. Drugs that cause gynaecomastia include:
Cimetidine, omeprazole, spironolactone, digoxin, furosemide,
finasteride and some anti-pyschotics. b) T. The statement is true.
c) T. The statement is true. d) F. The statement is false.
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Pharma: 8099
#9 Regarding antipsychotic drugs: a) Chlorpromazine is a
phenothiazine derivative. b) Prochlorperazine has more pronounced
extrapyramidal side effects than pipotiazine. c) Amisulpiride has a
low affinity for mesolimbic D2 and D3 receptors. d)
Contraindications to use include phaechromocytoma.
Explanations: a) T. Chlorpromazine is a group 1, first
generation, antipsychotic drug. It is a phenothiazine derivative
and acts by non-selectively blocking dopamine receptors in the
brain. b) T. Prochlorperazine is a group 3, first generation,
antipsychotic drug. Pipotiazine is a group 2, first generation,
antipsychotic drug. Group 3 drugs have more pronounced
extrapyramidal side effects than group 1 or 2 drugs but generally
have more pronounced sedative and anti-muscarinic side effects. c)
F. Amisulpiride is a second generation, or atypical, antipsychotic
drug. It has a high affinity for mesolimbic D2 and D3 receptors. d)
T. The contraindications to the use of antipsychotic drugs include:
Reduced conscious level / coma CMS depression Phaeochromocytoma
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Pharma: 8145
#1 Codeine phosphate: a) Common adverse effects include seizures
and respiratory depression. b) Is metabolized via the cytochrome
p450 system in the liver. c) Has a half-life of 6-8 hours. d) Can
be safely administered orally and intravenously.
Explanations: a) F. Seizures and respiratory depression are rare
adverse effects of codeine at therapeutic doses. The commonest side
effects are drowsiness, constipation and nausea. b) T. The
statement is true. c) F. Codeine phosphate has a half-life of 2.5-3
hours. d) F. Codeine is not recommended via the intravenous route
due to the risks of severe hypotension and death due to histamine
release and myocardial depression.
Pharma: 8124
#3 Aspirin: a) Reversibly inhibits cyclo-oxygenase. b) Has an
anti-inflammatory effect at low doses. c) Usage can produce gastric
irritation and erosion. d) Reduces the risk of stroke and
myocardial infarction.
Explanations: a) F. Aspirin irreversibly blocks cyclo-oygenase
by covalently acetylating the cyclo-oxygenase active site in both
COX-1 and COX-2. b) F. At low doses (75 mg per day) aspirin only
inhibits COX-1, the enzyme responsible for making thromboxane A2,
and therefore principally exhibits an anti-thrombotic effect. At
medium to high doses (500-5000 mg per day) aspirin inhibits both
COX-1 and COX-2. COX-2 is responsible for the production of
prostaglandins and therefore has an anti-inflammatory effect at
these doses. c) T. Chronic aspirin usage can produce gastric
irritation and erosion, GI haemorrhage, vomiting and renal tubular
necrosis. d) T. This is due to its anti-thrombotic effects.
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Pharma: 8132
#4 In overdose with antidepressant drugs: a) Tricylic
antidepressants (TCAs) are safer than selective serotonin reuptake
inhibitors (SSRIs). b) Tricyclic antidepressant cause a metabolic
alkalosis. c) Serotonin syndrome may occur. d) Atropine can be used
to reverse anticholinergic effects.
Explanations: a) F. SSRIs are far safer than TCAs in overdose.
SSRIs are rarely fatal in overdose when taken alone. b) F. TCAs
cause a metabolic acidosis. c) T. Serotonin syndrome is a
recognized feature with overdose of antidepressant drugs. d) F.
Atropine itself is an anticholinergic drug and would worsen any
anticholinergic effects present.
Pharma: 8121
#6 Metoclopramide: a) Is a dopamine receptor agonist. b) Is a
gastric prokinetic. c) Should be avoided in pregnancy. d) Can cause
neuroleptic malignant syndrome.
Explanations: a) F. Metoclopramide exerts its anti-emetic action
via dopamine D2-receptor antagonist. At high doses it is also
thought to have 5-HT3 antagonist activity. b) T. Metoclopramide
exerts its gastric prokinetic activity via dopamine D2-receptor
antagonism, antimuscarinic activity and 5-HT4 antagonist activity.
c) F. The statement is false. d) T. Metoclopramide is a recognized
cause of neuroleptic malignant syndrome.
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Pharma: 8056
#7 Regarding amiodarone: a) It is a class III anti-arrhythmic
agent. b) Can be used in the management of ventricular
fibrillation. c) Is a cytochrome p450 enzyme inducer. d) Should be
made up using 0.9% saline solution.
Explanations: a) T. Amiodarone is a class III anti-arrhythmic
agent. b) T. Amiodarone is used in the management of shock
refractory VF arrests. c) F. Amiodarone is a cytochrome p450 enzyme
inhibitor. d) F. Amiodarone is incompatible with 0.9% saline and
should be made up using 5% dextrose solution.
Pharma: 8142
#10 Naloxone: a) Is a competitive partial opioid agonist. b) Has
a high affinity for -opiod receptors. c) The initial dose is
400-800 mg IV. d) Has a longer half-life than morphine.
Explanations: a) F. Naloxone is a competitive opioid antagonist.
b) T. The statement is true. c) F. The initial dose is 400-800 g
IV. This can be repeated every 2-3 minutes up to a cumulative dose
of 10 mg. d) F. The half-life of naloxone is shorter than that of
morphine.
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Pharma: 8051
#1 Drug doses in paediatric cardiac arrest: a) Adrenaline 5
mcg/kg. b) Amiodarone 5 mg/kg. c) Magnesium 25-50 mg/kg. d)
Lidocaine 0.1 mg/kg.
Explanations: a) F. Adrenaline 10 mcg/kg. b) T. The statement is
true. c) T. The statement is true. d) F. Lidocaine 1 mg/kg.
Pharma: 8002
#2 Aluminium hydroxide: a) Is used as an antacid. b) Tends to
have a laxative effect. c) Is relatively water soluble. d) Can be
used in the treatment of hypophosphataemia.
Explanations: a) T. The statement is true. b) F. Aluminium
containing antacids tend to be constipating. c) F. It is relatively
water insoluble. d) F. It is used occasionally in the treatment of
hyperphosphataemia. It is a phosphate binder and is therefore
contraindicated in the presence of hypophosphataemia.
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Pharma: 8010
#5 Adenosine: a) Blocks the atrioventicular node. b) The dose
for the treatment of supraventricular tachycardia is 6-12 mg IV. c)
The dose should be reduced in patients taking theophyllines. d) The
dose should be reduced in patients taking clopidogrel.
Explanations: a) T. The statement is true. b) T. The statement
is true. c) F. The dose may be increased in patients taking
theophyllines as theophylline prevents binding of adenosine at
receptor sites. d) F. The dose should be reduced in patients taking
dipyridamole as adenosine potentiates the effect of this drug.
Pharma: 8148
#6 Carbemazepine: a) Can be used as a mood stabilizer. b) Levels
should be routinely monitored. c) Is a cytochrome p450 enzyme
inhibitor d) Stabilizes the inactivated state of voltage-gated
sodium channels.
Explanations: a) T. Carbemazepine is used as an antiepileptic, a
mood stabilizer in the treatment of bipolar effective disorder and
as an analgesic in the treatment of neuropathic pain. b) F.
Carbemazepine levels do not require routine monitoring. NICE
advises monitoring of levels under in the following circumstances:
Suspected non-adherence to the prescribed medication Suspected
toxicity Under periods of dose adjustment Whilst managing
pharmacokinetic interactions In specific clinical circumstances
e.g. status epilepticus, organ failure and pregnancy c) F.
Carbemazepine is a cytochrome p450 enzyme inducer d) T.
Carbemazepine acts by stabilizing the inactivated state of
voltage-gated sodium channels and also by potentiating GABA
receptors.
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Pharma: 8032
#7 Metaraminol: a) Acts mainly on beta adrenergic receptors. b)
Its main action is peripheral vasoconstriction. c) Is positively
chronotropic. d) Is positively inotropic.
Explanations: a) F. Acts mainly as an alpha1 adrenergic receptor
agonist with a lesser action on beta adrenergic receptors. b) T.
This is mediated via alpha1 adrenergic receptors. c) F. It causes a
reflex bradycardia. d) T. The statement is true.
Pharma: 8037
#8 Recognised side effects of Ecstasy include: a)
Hepatoctoxicity. b) Fulminant hyperthermia. c) Rhabdomylosis. d)
Cerebrovascular accident.
Explanations: a) T. Ecstasy is a phenylethylamine compound with
similarities to amphetamines and mescaline. Recognised side effects
include: fulminant hyperthermia, convulsions, rhabdomylosis,
inappropriate ADH secretion, DIC, liver failure and cerebrovascular
accidents. b) T. The statement is true. c) T. The statement is
true. d) T. The statement is true.
Pharma: 8039
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#9 Regarding mephedrone: a) It is structurally similar to
amphetamine. b) Myalgia, chest pain and tachycardia are common side
effects. c) It is associated with a high incidence of prolonged
hospital admission and death. d) Purchase is currently legal.
Explanations: a) T. Mephedrone, also known as M-CAT is a
synthetic compound based on the naturally occurring
phenylalkylamine cathionone from the Khat plant. It is structurally
similar to amphetamine. b) T. The commonest side effects are:
headache, vomiting, nausea, tachycardia, dyspnoea, chest pain and
myalgia. c) F. Preliminary case series have shown no association
with prolonged hospital admission or death when taken alone. d) F.
Its was classified a class B drug in March 2010 and
delegalised.
Pharma: 8096
#10 Regarding diazepam: a) It enhances effects of the
neurotransmitter gamma-aminobutyric acid (GABA). b) Is
short-acting. c) Should be avoided in hepatic impairment. d)
Crosses into breast milk.
Explanations: a) T. Diazepam enhances the effects of GABA
resulting in sedative, hypnotic, anxiolytic, anticonvulsant and
muscle relaxant properties. b) F. Diazepam is a long-acting
benzodiazepine with a half-life of 20-100 hours. Examples of
short-acting benzodiazepines with a half-life of less than 12 hours
include midazolam, oxazepam and alprazolam (Xanax). c) T.
Benzodiazepines can precipitate coma if used in hepatic impairment.
If treatment is required benzodiazepines with shorter half-lives in
reduced doses should be used. d) T. The statement is true.
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Pharma: 8009
#1 Mannitol: a) The IV dose of mannitol is 0.25-2 g/kg over 1
hours. b) Is an osmotic diuretic. c) Can be used in the treatment
of congestive cardiac failure. d) IV injection can cause
thrombophlebitis.
Explanations: a) T. The statement is true. b) T. The statement
is true. c) F. Mannitol causes an expansion of the extracellular
fluid space which may worsen congestive cardiac failure. d) T.
Extravasation causes inflammation and thrombophlebitis.
Pharma: 8077
#2 Ipratropium bromide: a) Is an anti-muscarinic drug. b) The
BTS guidelines recommend its use in the immediate management of
acute severe asthma. c) Commonly causes tremor as a side effect. d)
Should be used with caution in patients with prostatic
hyperplasia.
Explanations: a) T. Ipratropium bromide is an anti-muscarinic
drug used in the management of acute asthma and COPD. b) F. The BTS
guidelines recommend the use of ipratropium bromide in acute severe
asthma if there is no response to immediate management after 15-30
minutes. The immediate management of acute severe asthma is high
flow oxygen, inhaled salbutamol via large-volume spacer or
nebulizer and corticosteroid administration. The BTS guidelines
recommend the use of ipratropium bromide in the initial management
of life threatening asthma. c) F. The commonest side effect of
ipratropium bromide is dry mouth. It can also cause constipation,
cough, paroxysmal bronchospasm, headache, nausea, palpitations and
urinary retention. d) T. Ipratropium bromide can cause urinary
retention in patients with prostatic hyperplasia and bladder
outflow obstruction. It can also trigger acute closed angle
glaucoma in susceptible patients.
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Pharma: 8125
#3 Regarding aspirin: a) It inhibits prostaglandin production at
low doses. b) It can be given as an anti-pyretic for childhood
viral illness. c) Resistance is more common in men than women. d)
Long term use predisposes to colon cancer.
Explanations: a) F. At low doses (75 mg per day) aspirin only
inhibits COX-1, the enzyme responsible for making thromboxane A2,
and therefore principally exhibits an anti-thrombotic effect. At
medium to high doses (500-5000 mg per day) aspirin inhibits both
COX-1 and COX-2. COX-2 is responsible for the production of
prostaglandins and therefore has an anti-inflammatory effect at
these doses. b) F. When used as an anti-pyretic for childhood viral
illness, aspirin can cause Reyes syndrome. Reyes syndrome is a
potentially fatal disease that causes liver failure and
encephalopathy. c) F. Aspirin resistance is the inability of
aspirin to reduce platelet production of thromboxane A2 and thereby
platelet activation and aggregation. The exact frequency and
mechanism of aspirin resistance are not known, however it may occur
in approximately 1% of users. This phenomenon occurs more commonly
in women than men. d) F. Recent research suggests that regular
aspirin usage reduces the risk of colorectal cancer. It may also
have a protective effect in breast, bladder, prostate and lung
cancer.
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Pharma: 8004
#4 Regarding the treatment of peptic ulcers: a) The proton pump
is the terminal stage in gastric acid secretion. b) The use of
proton pump inhibitors reduces the risk of re-bleeding following
endoscopic treatment of bleeding peptic ulcers. c) The use of
proton pump inhibitors is associated with an increased risk of
community acquired pneumonia. d) The use of intravenous rather than
oral proton pump inhibitors is associated with a better outcome in
the management of acute peptic ulcer bleeding.
Explanations: a) T. This makes the proton pump an ideal target
for inhibiting acid secretion. b) T. The statement is true. c) T.
It is suspected that acid suppression results in poor elimination
of pathogenic organisms leading to increased infection risk. d) F.
The outcome is similar with both oral and intravenous PPI use.
Pharma: 8019
#5 Regarding sodium nitroprusside: a) It is a potent
vasodilator. b) It is the drug of choice in the management of
hypertensive crises requiring parenteral treatment. c) It has a
half life of 1-2 hours. d) It must be stored in a dark area.
Explanations: a) T. The statement is true. b) T. The statement
is true. c) F. It's half life is 1-2 minutes. The metabolite
thiocyanate has a half life of several days. d) T. Sodium
nitroprusside breaks down to release 5 cyanide ions upon exposure
to UV light.
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Pharma: 8058
#6 Amiodarone: a) Has a short half-life. b) Rarely causes
corneal microdeposits. c) Commonly causes optic neuritis. d) Can be
used in the management of sinus node disease.
Explanations: a) F. Amiodarone has a very long half-life, which
can be as long as several weeks. b) F. Most patients taking
amiodarone develop corneal microdeposits, this reverses after
treatment has been ceased and rarely interferes with vision. c) F.
Optic neuritis is a very rare side effect of amiodarone. If it does
occur then the amiodarone should be stopped immediately due to the
risk of blindness. d) F. Amiodarone is contra-indicated in the
presence of sinus node disease.
Pharma: 8091
#7 Regarding the use of antihistamines: a) Cetirizine is an
H2-receptor antagonist. b) The dose of chlorphenamine in
anaphylaxis is 10 mg IV. c) Loratadine is non-sedating. d) They can
be used in the management of C1-esterase inhibitor deficiency.
Explanations: a) F. Cetirizine is a selective H1-receptor
antagonist. b) T. The statement is true. c) T. The statement is
true. d) F. Antihistamines are ineffective in the management of
C1-esterase inhibitor deficiency.
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pharma: 8063
#9 The following drugs inhibit the effects of warfarin: a)
Phenytoin. b) Sodium valproate. c) Isoniazid. d) Rifampicin.
Explanations: a) T. Cytochrome p450 enzyme inducers inhibit the
effects of warfarin resulting in a reduced INR. The mnemonic PC
BRASS can be used to memorise the commonly encountered cytochrome
p450 enzyme inducers: P - Phenytoin C - Carbemazepine B -
Barbiturates R - Rifampicin A - Alcohol (chronic ingestion) S -
Sulphonylureas S - Smoking b) F. Sodium valproate is a cytochrome
p450 enzyme inhibitor and potentiates the effects of warfarin
(increases the INR). c) F. Isoniazid is a cytochrome p450 enzyme
inhibitor and potentiates the effects of warfarin (increases the
INR). d) T. The statement is true.
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Pharma: 8102
Lithium: a) Therapeutic levels are 1.4-2.0 mmol/l. b) Has an
elimination half-life of 20-24 hours. c) Side effects include
polyuria and polydipsia. d) Interact with thiazide diuretics.
Explanations: a) F. Therapeutic levels of lithium are < 1.2
mmol/l. Lithium toxicity occurs at levels above 1.5 mmol/l. b) T.
The statement is true. c) T. Common side effects of lithium
include: Tremor Nausea and vomiting Muscle weakness Nephrogenic
diabetes insipidus (causing polyuria and polydipsia) Hypothyroidism
Depletion of calcium from bone d) T. Lithium interacts with
thiazide diuretics and other sodium depleting drugs increasing the
risk of lithium toxicity. ACE inhibitors and NSAIDs also reduce
lithium excretion and increase the risk of lithium toxicity.
Pharma: 8144
#8 Regarding opioid analgesics: a) 1 mg of IV morphine is
equivalent to 20 mg of oral codeine. b) 1 mg of IV diamorphine is
equivalent to 1.5 mg of IV morphine. c) True allergic reactions are
common. d) Morphine is a phenylpiperadine derivative.
Explanations: a) T. 1 mg of IV morphine is equivalent to 3 mg of
oral morphine and 20 mg of oral codeine. b) T. 1 mg of IV
diamorphine is equivalent to 1.5-1.8 mg of IV morphine. c) F. True
allergic reactions to opioids are rare. d) F. Morphine is a
phenanthrene derivative. Pethidine is an example of a
phenylpiperadine derivative.
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Pharma: 8147
#1 Tramadol: a) Is a strong -opioid receptor agonist. b)
Inhibits the reuptake of noradrenaline. c) Blocks serotonin
release. d) Has a half-life of 5-7 hours.
Explanations: a) F. Tramadol is a weak -opioid receptor agonist
but is converted to O-desmethyltramadol, which has a much higher
-opioid receptor agonist activity. b) T. The statement is true. c)
F. Tramadol induces serotonin release and its co-prescription with
tricyclic antidepressants and serotonin reuptake inhibitors should
be avoided or approached with caution as a consequence of this. d)
T. The statement is true.
Pharma: 8054
Features of atropine toxicity include: a) Hypothermia. b)
Hallucinations. c) Miosis. d) Urinary retention.
Explanations: a) F. Atropine is a competitive antagonist of
muscarinic cholinergic receptors and has the following effects:
Nausea, dizziness, blurred vision (secondary to mydriasis and
cycloplegia), photophobia, dry mouth, urinary retention, increased
temperature (secondary to inhibition of sweating), tachycardia,
confusion and hallucinations. b) T. The statement is true. c) F.
Atropine causes mydriasis and cycloplegia. d) T. The statement is
true.
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Pharma: 8085
#4 Drug doses in adult asthma: a) Ipratropium bromide 100 mcg
via oxygen-driven nebuliser. b) Salbutamol 5 mg via oxygen-driven
nebuliser. c) Hydrocortisone 100 mg IV. d) Magnesium Sulphate 8 mg
IV.
Explanations: a) F. Ipratropium bromide 500 mcg via
oxygen-driven nebuliser. b) T. The statement is true. c) T. The
statement is true. d) F. Magnesium sulphate 1.2-2 g IV (over 20
minutes)
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Pharma: 8130
#2 The following are common features of salicylate poisoning: a)
Tinnitus. b) Hyperpyrexia. c) Hypokalaemia. d)
Thrombocytopenia.
Explanations: a) T. Common features of salicylate poisoning
include: Nausea and vomiting Tinnitus Lethargy Dizziness
Restlessness Sweating Bounding pulses Warm extremities
Hyperventilation b) F. Uncommon features of salicylate poisoning
include: Haematemesis Hyperpyrexia Hypoglycaemia Thrombocytopaenia
Disseminated intravascular coagulation Renal failure
Non-cardiogenic pulmonary oedema c) F. The statement is false. d)
F. The statement is false.
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Pharma: 8055
#5 Atropine: a) Is a non-competitive muscarinic cholinergic
receptor blocker. b) Poisoning can be reversed using physostigmine.
c) Crosses the blood brain barrier. d) The dose used in paediatric
bradycardia is 1-2 mcg/kg.
Explanations: a) F. Atropine is a competitive antagonist of
muscarinic cholinergic receptors. b) T. Physostigmine is a
reversible cholinesterase inihibitor that can be used in atropine
toxicity. c) T. Atropine crosses the blood brain barrier and as a
consequence it has CNS side effects such as confusion and
hallucinations associated with its use. d) F. The dose used in
paediatric bradycardia is 10-20 mcg/kg.
Pharma: 8074
#6 Regarding the following antiplatelet drugs: a) Aspirin is a
phosphodiesterase inhibitor. b) Clopidogrel inhibits glycoprotein
IIb/IIIa. c) Ticlodipine is a thienopyridine class agent. d)
Prasugrel is licensed for use in diabetic patients with acute
coronary syndromes undergoing percutaneous coronary intervention
(PCI).
Explanations: a) F. Aspirin prevents thromboxane A2 formation by
irreversibly inhibiting cyclo-oxygenase. Dipyridamole acts as a
phosphodiesterase inhibitor and acts to inhibit the conversion of
cAMP to inactive 5' AMP. b) F. Clopidogrel inhibits ADP-mediated
platelet aggregation. c) T. The thienopyridine class agents are
prasugrel, ticlodipine and clopidogrel. They all act by inhibiting
the ADP receptor. Ticlodipine has an increased risk of thrombotic
thrombocytopenic purpura and neutropenia so its use has been
largely supplanted by that of clopidogrel. d) T. Prasugrel is
licensed for use in patients with acute coronary syndromes
undergoing percutaneous coronary intervention. The TRITON-TIMI 38
study showed that prasugrel was associated with a significantly
lower incidence of ischaemic events than clopidogrel and was
particularly effective in patients with diabetes mellitus.
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Pharma: 8067
#7 Regarding warfarin: a) The INR should be between 3 and 4 for
patients with prosthetic heart valves. b) It affects the synthesis
of factors III, XI and protein S. c) It is contraindicated in
breast-feeding. d) Overdose can be treated with oral vitamin K.
Explanations: a) T. The INR should be kept between 3 and 4 for
high-risk patients such as those with prosthetic heart valves and
recurrent thromboemobolism. b) F. Warfarin is a vitamin K
antagonist that affects the synthesis of factors II, VII, IX, X and
protein C. c) F. Warfarin is not present in significant amounts in
breast milk and appears to be safe in breast-feeding. d) T.
Treatment of warfarin overdose depends upon both the INR and the
presence of major bleeding. If there are risk factors for bleeding
but no active bleeding then oral vitamin K alone can be given.
However in the presence of bleeding the INR will need to be more
rapidly corrected with IV vitamin K and factor concentrate.
Pharma: 8087
#8 Aminophylline: a) Contains ethylenediamine. b) Acts as a
phosphodiesterase inhibitor. c) Potentiates the effects of
dipyridamole. d) Is more potent than theophylline.
Explanations: a) T. Aminophylline is a compound of theophylline
with ethylenediamine in a 2:1 ratio. The ethylenediamine improves
its solubility. b) T. Aminophylline acts as both a
phosphodiesterase inhibitor and a non-selective adenosine receptor
antagonist. c) F. Aminophylline inhibits the effects of
dipyridamole. d) F. Aminophylline is less potent and shorter acting
than theophylline.
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Pharma: 8126
#9 Regarding aspirin: a) It is a competitive cyclo-oxygenase
antagonist. b) At low doses it inhibits the production of
thromboxane A2 by platelets. c) Side effects include renal tubular
necrosis. d) The effects of a single dose last 7-10 days.
Explanations: a) F. Aspirin is a non-competitive cyclo-oxygenase
antagonist. It works by covalently acetylating the cyclo-oxygenase
active site in both COX-1 and COX-2. b) T. At low doses (75 mg per
day) aspirin only inhibits COX-1, the enzyme responsible for making
thromboxane A2, and therefore principally exhibits an
anti-thrombotic effect. At medium to high doses (500-5000 mg per
day) aspirin inhibits both COX-1 and COX-2. COX-2 is responsible
for the production of prostaglandins and therefore has an
anti-inflammatory effect at these doses. c) T. Chronic aspirin
usage can produce gastric irritation and erosion, GI haemorrhage,
vomiting and renal tubular necrosis. d) T. The effects of a single
dose of aspirin last 7-10 days, the time required for the bone
marrow to generate new platelets.
Pharma: 8146
#10 Codeine phosphate: a) Is a moderate agonist at -opioid
receptors. b) Can be used in the management of diarrhoea. c) Has
half the potency of dihydrocodeine. d) 1 mg of IV morphine is
equivalent to 10 mg of oral codeine.
Explanations: a) T. The statement is true. b) T. Codeine is used
as an analgesic, an antitussive and as an antidiarrhoeal. c) F.
Codeine phosphate and dihydrocodeine have similar potencies. d) F.
1 mg of IV morphine is equivalent to 3 mg of oral morphine and 20
mg of oral codeine.
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Pharma 8029
Ephedrine: a) Causes the release of adrenaline from sympathetic
nerve terminals. b) Acts on both alpha and beta adrenergic
receptors. c) The parenteral dose is 3-30mg titrated to response.
d) Causes a marked increase in systemic vascular resistance.
Explanations: a) F. Ephedrine causes the release of
noradrenaline from sympathetic nerve terminals. b) T. The statement
is true. c) T. The statement is true. d) F. Peripheral
vasoconstriction is balanced by vasodilation with little overall
change in systemic vascular resistance.
Pharma: 8084 Relative steroid potency: a) Dexamethasone is 6
times more potent than hydrocortisone. b) Methylprednisolone is 5
times more potent than hydrocortisone. c) Prednisoloone is 4 times
more potent than hydrocortisone. d) Hydrocortisone is 5 times more
potent than triamcinolone.
Explanations: a) F. Relative to hydrocortisone: Dexamethasone is
25 times more potent Methylprednisolone is 5 times more potent
Triamcinolone is 5 times more potent Prednisolone is 4 times more
potent b) T. The statement is true. c) T. The statement is true. d)
F. The statement is false.
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Pharma: 8013
Regarding the clinical use of beta blockers: a) Labetolol is
used in the management of hypertension in acute stroke. b) Atenolol
crosses the blood brain barrier. c) Bisoprolol has a half life of
10-12 hours. d) Propranolol can be used in the prophylaxis of
migraine.
Explanations: a) T. Labetolol is indicated if the systolic BP is
> 220 mmHg or the diastolic BP is > 120 mmHg. Treating
hypertension in acute stroke has been shown to reduce the risk of
intracranial haemorrhage. b) F. Atenolol dose not cross the blood
brain barrier. c) T. The statement is true. d) T. The statement is
true.